{
  "abstract": "Background Active inflammatory bowel disease (IBD) during pregnancy is associated with adverse outcomes. Real-world data identifying predictors of poor outcomes and evaluating impact of models of care remain limited. This aim was to assess outcomes of pregnant women with active IBD and the impact of IBD–antenatal care (IBD-ANC).Methods A UK multicentre retrospective study included pregnant women with active IBD, defined by symptoms and/or raised inflammatory markers (FCAL ≥250 μg/g or CRP ≥5 mg/L), and treatment escalation during pregnancy. Two composite endpoints were assessed:adverse IBD outcome - IBD-related hospitalisation or IBD-related surgeryadverse pregnancy or neonatal outcome - ≥1 of pregnancy loss, small-for-gestational-age, fetal growth restriction, low birthweight (<2500g), preterm birth, pre-eclampsia, placental abruption, maternal or neonatal infection requiring antibiotics, low 5 minute APGAR score, NICU admission, or congenital defect. Multivariable logistic regression generated adjusted relative risk ratios (aRRR), controlling for maternal age, BMI and smoking status at conception.Results The study included 389 pregnancies across 16 UK hospitals; 81.2% received care through a dedicated IBD-ANC clinic. Adverse IBD outcomes occurred in 21.3% (n=83), including 78 admissions, 4 requiring inpatient surgery and 1 outpatient surgery. Factors associated with an adverse IBD outcome included: disease duration <1 year at time of conception (aRRR 4.18; 95% CI 1.44-12.09, p=0.008), exposure to ≥3 biologics (aRRR 3.90; 95% CI 1.41-10.80, p=0.009), moderate-severe disease activity within the 6 months prior to conception (aRRR 3.59; 95% CI 1.60-8.03, p=0.002) or at time of conception (aRRR 3.40; 95% CI 1.70-6.78, p=0.001),those requiring corticosteroids (aRRR 9.70; 95% CI 4.86-19.35, p<0.005) or biologics (aRRR 3.39; 95% CI 1.69-6.80, p=0.001) in pregnancy. These patients also had an increased rate of emergency c-section (ECS) (aRRR 2.95; 95% CI 1.14-7.63, p=0.026). In contrast, management through an IBD-ANC clinic was protective (aRRR 0.48; 95% CI 0.24-0.95, p=0.034).An adverse pregnancy or neonatal outcome occurred in 32.9% (n=128), associated with smoking prior to pregnancy (aRRR 2.45; 95% CI 1.19-5.03, p=0.015), persistent moderate disease post-induction of definitive therapy (aRRR 2.26; 95% CI 1.05-5.32, p=0.038) and ECS (aRRR 3.13, 95% CI 1.56–6.26; p=0.001). Management through IBD-ANC was protective (aRRR 0.39; 95% CI 0.21-0.70, p=0.002).Conclusion Pregnant women with active IBD represent a high-risk cohort requiring targeted pre-conception counselling and enhanced monitoring. Care delivered through a dedicated IBD-ANC was associated with fewer adverse IBD-related and pregnancy outcomes, supporting this model as standard of care for managing IBD in pregnancy.",
  "authors": [
    {
      "affiliations": [
        "The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom",
        "The Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "Krishna Shah"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Christian Selinger"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Jie Han Yeo"
    },
    {
      "affiliations": [
        "Royal Victoria Infirmary, Newcastle, United Kingdom"
      ],
      "name": "Melanie Gunn"
    },
    {
      "affiliations": [
        "Northern Care Alliance Manchester, Manchester, United Kingdom"
      ],
      "name": "Hannah Morgan"
    },
    {
      "affiliations": [
        "West Middlesex Hospital, London, United Kingdom"
      ],
      "name": "Emma Johnston"
    },
    {
      "affiliations": [
        "Edinburgh Inflammatory Bowel Diseases Unit, Western General Hospital, Edinburgh, United Kingdom"
      ],
      "name": "Amirhosein Kefayat"
    },
    {
      "affiliations": [
        "Homerton University Hospital, London, United Kingdom"
      ],
      "name": "Nora Thoua"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals NHS trust, London, United Kingdom"
      ],
      "name": "Amit Thakor"
    },
    {
      "affiliations": [
        "King’s College Hospital NHS Trust, London, United Kingdom"
      ],
      "name": "Alexandra Kent"
    },
    {
      "affiliations": [
        "Imperial College Hospital NHS Trust, London, United Kingdom"
      ],
      "name": "Lucy Hicks"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Rachel Cooney"
    },
    {
      "affiliations": [
        "Hull University Teaching Hospitals, Hull, United Kingdom"
      ],
      "name": "Shaji Sebastian"
    },
    {
      "affiliations": [
        "Whipps Cross Hospital, London, United Kingdom"
      ],
      "name": "Cameron Braddy-Green"
    },
    {
      "affiliations": [
        "Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom"
      ],
      "name": "Hannah Gordon"
    },
    {
      "affiliations": [
        "Newham Hospital, London, United Kingdom"
      ],
      "name": "Noor Jawad"
    },
    {
      "affiliations": [
        "King’s College Hospital NHS Trust, London, United Kingdom"
      ],
      "name": "Kathryn Dalrymple"
    },
    {
      "affiliations": [
        "The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom",
        "The Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "Gareth Parkes"
    },
    {
      "affiliations": [
        "The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom",
        "The Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "James O Lindsay"
    },
    {
      "affiliations": [
        "The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom",
        "The Blizzard Institute, Queen Mary University London, London, United Kingdom"
      ],
      "name": "Klaartje Kok"
    }
  ],
  "title": "P194 Multidisciplinary IBD-antenatal care is associated with lower IBD related hospitalisation and reduced rates of adverse pregnancy or neonatal outcomes",
  "uid": "cc987cae-d71b-566e-b23d-f8645973c5bb"
}